Long-Distance Medicine

Perumal Pillai, seventy-five, lives at Grace Care Center, an orphanage and elder care facility in Sri Lanka. For seven years he was blind.

Then, five months ago, Pillai had surgery to remove cataracts from one eye. He's still waiting for an operation on the other, but he's already regained enough vision to see his two daughters for the first time in years--which, he says, gave him new reason to live.

The person who first realized Pillai's blindness might be treatable was a medical student at the University of Michigan. For the last eight months, Pillai and four other residents of the Sri Lankan facility have received group medical consultations from five U-M medical students via Skype.

Naresh Gunaratnam, a gastroenterologist in Ann Arbor who was born in Sri Lanka, has worked with Grace since 2002, when the nonprofit was founded to house children and senior citizens affected by the civil war there.

For nearly a decade, Gunaratnam saw patients at Grace succumbing to illness for lack of medical intervention.

"It was very random and very reactive," he says. "We didn't have a systematic health care protocol. If [residents] got sick, we'd take them to the hospital. But there was no preventative care, there was no primary care."

Last October, using Skype and the electronic health record system Enki, he began connecting the Grace residents with medical students here for a pilot program in weekly primary care.

He started small, focusing on the patients' blood pressure, which can be taken by nonmedical staff at Grace and tracked easily. Since then, as the students and patients have gotten to know one another better, they and Gunaratnam have offered suggestions for follow-up by Sri Lankan physicians. In Pillai's case, they learned that he had lost his sight gradually over a period of years and could still discern light from dark--both indicators that he might have cataracts.

Since a local doctor visits Grace for only an hour once a month, Gunaratnam views the

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Skype sessions as a way of "filling in the gaps" in residents' care. "We're augmenting the care and identifying things that [the local doctor] should be worried about and making the appropriate recommendations," he says.

Telemedicine is not new. But Gunaratnam says it's been typically used only when a medical specialist consults a patient in a foreign country that lacks the needed specialists. Rarely, if ever, is telemedicine used consistently for primary care. If these trial sessions continue to prove successful, he aims to take this health-care model to other parts of the world lacking in primary care, including places in the United States.

"I think it's even more relevant to the American medicine that we'll be practicing than we might realize," says third-year medical student Rashmi Patil. "Things like limited access to health resources--Americans face that every day. Things like cultural barriers and language restrictions--we'll be facing that every day."